STATE

Legislature

The short session will begin on April 24, 2024, and is scheduled to run through July 31, 2024. The legislature also scheduled non-voting sessions (February 14-15, March 13-14, and April 10-11) to address appointments, vetoes, and other matters. As a reminder, the short session is a time to review and adjust the state’s two-year budget that was adopted last year. So, lawmakers may only consider new legislation that impacts the budget or bills that passed during the long session. It is expected that the legislators will likely avoid highly controversial issues and bills since it is an election year.

The short session is an opportunity to continue to educate and advocate around the need for more Innovations Waiver slots and the additional funds needed to increase Direct Support Professional (DSP) rates to at least $18 an hour.

Appendix K Flexibilities

The Centers for Medicare and Medicaid Services (CMS) recently approved North Carolina Medicaid to continue certain Appendix K flexibilities in the 1915 (c) Innovations Waiver and Traumatic Brain Injury (TBI) Waiver amendment, effective March 1, 2024. CMS allowed states to use Appendix K during the public health emergency related to COVID. Some of the flexibilities will continue and others will end February 29, 2024.

Some of the on-going flexibilities include:

• Increase the Innovations waiver cap from $135,000 to $184,000 per waiver year.
• Allow parents of minor children receiving Community Living and Support to provide this service to their child who has been indicated as having extraordinary support needs up to 40 hours/week.
• Allow Supported Living to be provided by relatives.
• Allow relatives as providers for adult waiver members to provide above 56 hours/week, not exceeding 84 hours/week of Community Living and Supports. 

NC Medicaid will work with the LME-MCOs to support members in transitioning from the Appendix K flexibilities that will be discontinued in the Innovations and TBI Waiver amendments by March 1, 2024. 

For more information on flexibilities approved for the Innovations and TBI waivers, please see the NC Medicaid Innovations Waiver webpage.

FEDERAL

Budget and Appropriations

Congress returned from the holiday recess and began work on the funding for Fiscal Year 2024. On January 7, 2024, a bi-partisan agreement on funding levels for 2024 was released. This agreement includes the same funding levels that were part of the Fiscal Responsibility Act signed in June 2023 which suspended the limit on the federal debt and made some changes to federal spending limits. Having the top funding levels allows the House and Senate to continue work on appropriations bills.

Another aspect of their work is the Continuing Resolution (CR) which continues last year’s funding while Congress works to complete the budget process. The CR which was signed by the President in November 2023 was set to expire for some agencies on January 19, 2024, and other agencies on February 2, 2024. On January 18, 2024, Congress passed another CR extending funding for appropriated programs through March 1, 2024 (Agriculture, Military Construction/VA, Energy/Water, and Transportation/Housing and Urban Development bills) and through March 8, 2024 (Labor-HHS-Education, Defense, State/Foreign Operations, Commerce/Justice/Science, Financial Services, Interior/Environment, Legislative Branch, and Homeland Security bills). The next several weeks will be busy to meet the new deadlines.

Healthcare Accessibility

The US Department of Justice is proposing a rule under the Americans with Disabilities Act (ADA) to improve access to healthcare for people with disabilities. The rule would set standards detailing the responsibilities of hospitals and healthcare clinics under the law.  Under the proposal, state and local government entities that provide health care would be barred from denying services to patients with disabilities because of a lack of accessible equipment and such providers would be prohibited from requiring people with disabilities to bring someone to help them with an exam.

The proposal is the result of numerous complaints from people with disabilities who have experienced difficulty getting basic services by health care providers due to a lack of accessible equipment. The proposal is up for public comment through February 12, 2024.

Census Bureau Change

The Census Bureau has proposed a big change to some of the disability questions on its community survey that will reduce the number of people who are counted as having a disability. It is estimated that the change could reduce the number by 40%. Instead of simple “yes” and “no” questions, people will be asked to indicate how much difficulty they have with certain activities. The Census Bureau is recommending that only people who answer with “a lot of difficulty” or “cannot do at all” be counted as having a disability. 

This change is important because the numbers from the census affect federal funding and decisions government agencies make about accessible housing, public transportation, and civil rights enforcement. While the initial timeframe for public comments has passed, there will likely be another time for feedback in the Spring of 2024. Final approval from the White House Office of Management and Budget is needed by June 1, 2024 for any changes to show up in 2025.

ABLE Accounts

Beginning with the new year, people with disabilities will be allowed to put aside more money in their ABLE accounts. The annual deposit limit for ABLE accounts will increase to $18,000 from $17,000. People with disabilities can save more (up to $14,580 in addition) if they are employed and do not contribute to a retirement plan.

ABLE accounts are currently offered through state programs to people with a disability onset before age 26. But that age limit will rise to age 46 starting in 2026.

Exercising Your Right to Vote

Primary elections are coming in May and the general election will occur in November. Plan ahead to make sure you are ready to vote. The first step is making sure you are registered. Use this link to check your registration status: https://www.usa.gov/confirm-voter-registration.